Reply to Letter by Dr Demirtas et al “Cerebrovascular Events in Stenting for Carotid Artery Stenosis”

Abstract

We thank Dr Demirtas and colleagues for their interest in our study. The neutrophil to lymphocyte ratio (NLR) has been associated with periprocedural myocardial infarction (MI) in patients with nonurgent percutaneous coronary intervention (PCI). A recent meta-analysis involving 10 245 patients treated with PCI showed that a higher NLR increased the risk of angina, advanced heart failure, arrhythmia, major adverse cardiovascular events, cardiac mortality, all-cause mortality, in-stent thrombosis, nonfatal MI, and recanalization failure during hospitalization. Considering the similarity of PCI and carotid artery stenting (CAS), the periprocedure incidence of novel cerebral infarctions, whether symptomatic or asymptomatic, may be higher in patients with increased NLR. To detect novel cerebral infarctions, a series of magnetic resonance imaging (MRI) or computed tomography (CT) scans should be arranged. In this study, unfortunately, only some patients had at least one MRI or CT scan after procedure. The time of these neuroimaging examinations after CAS was very different. These situations prevented us to analyze the periprocedure incidence of cerebral infarction. We did follow the cerebrovascular events. Stroke occurred in 35 (8.2%) of 427 patients during a mean follow-up of 27.9 + 22.1 months. The 1-year cumulative incidence of stroke was 3.0%. However, increased NLR ( 2.13) was not significantly related to stroke occurrence during follow-up (hazard ratio 1⁄4 1.537; 95% confidence interval: 0.754-3.133, P 1⁄4 .230). The relatively lower incidence of stroke after procedure, which may due to the failure to report some vascular events, may be responsible for this result. Given the importance of this issue, further studies are warranted.